HYPERSENSITIVENESS 567 



marked distention — emphysema — of the chest; (3) wheezing and 

 sonorous sounds with both pliases of respiration, but especially with 

 expiration; (4) signs of circulatory disturbance — cyanosis and 

 distention of the blood vessels of the neck and face; (5) secretory 

 changes in the bronciiial mucosa usually producing a considerable 

 quantity of mucous casts, ])lugs, crystals, etc.; and (6) a standing 

 or sitting posture with arms and shoulders l)raced so as to bring 

 the muscles of expiration into best use." 



Brown also gives an excellent discussion of the early history and 

 theories of asthma. It has apparently been recognized clinically 

 since the time of Hippocrates. Cullen (1788) is said to be the 

 first to suggest ''that asthma might be the result of spasm of 

 muscles of the finer bronchi." According to Rackemann (1931) 

 the location of bronchial obstruction in asthma may be in the 

 larger bronchioles w'hen the interlocking fibers of the bronchial 

 muscles compress their openings; in the terminal bronchioles due 

 to the contraction of true sphincters ; or the bronchi may be, and 

 perhaps always are, obstructed to a greater or less degree by the 

 presence of a tenacious exudate within the lumen of the tube. It 

 is definitely established that the lungs are the "shock organs" in 

 asthma. The exciting agents are similar to those of hay fever and 

 other allergic conditions. 



Food Allergy. — Food allergy may express itself as vasomotor 

 rhinitis, asthma, urticaria (hives), or eczema. There is a great 

 deal of evidence that food allergy may also manifest itself as a 

 disturbance of the intestinal tract, or perhaps by a number of 

 other clinical symptoms. According to Rowe (1934), positive skin 

 tests are obtained in about 50 per cent of the cases of food allergy 

 and multiple sensitization is quite common. Piness and Miller 

 (1931) claim a much higher percentage of positive skin tests in 

 their series of cases. Vaughan (1930), Ellis (1931) and others 

 have carried out extensive studies on the grouping and classifica- 

 tion of the food allergins. They have proposed a biological 

 classification which is regarded by many as of distinct value in 

 interpreting skin tests and in devising "elimination diets." 

 Vaughan states (1930) that symptoms may be caused by members 

 of a food group to which the patient is skin negative. In his 

 opinion sensitivity to one member of a biological food group 

 warrants careful watching for the development of sensitiveness to 



